tv Washington This Week CSPAN October 12, 2013 11:00pm-1:01am EDT
any way to prevent the concern you have about the 3.5 million dollar check without imposing the limit on the person he wants to support 10 candidates? >> you could calculate inaccurate tabulation than the one that is here now. the you are making the argument that you cannot have aggregate limits. >> they are making the argument that the regulations that exist about transfers from one to -- that is what you are word about. but if they are not sufficient, it it could be bolstered. in a very blunt way trying to get at the problem. that is what you are worried
about. . is that wrong? fundraising committees, for one member to another -- >> again, i apologize for repeating myself, justice alito. and the receipt of the large text is a problem, corruption problem. none of them have adjusted that problem. >> i do not understand that. at the time they send money to this hypothetical joint, there is a corruption problem? what if they took the money and burned it? it would be a corruption problem? >> they will not burn it. >> when does the corruption occur? >> it occurs when it is transferred to the person and they want to corrupt. >> i beg to differ. -- when it is
delivered. that is the inherent risk of corruption in that situation. it is quite parallel to why we have aggregate limits and what you can give to a party. they are all on the scene team. they all have an interest in each other's success. they will have a sense of indebtedness. adjustuld, i will try to the circumvention problem. what they have done is come up with the whole series of things. it is not one thing you would have to do. transfer and segregated accounts. no giving money to packs who have indicated they'll give money to candidates. you have to do five or six things to deal with corruption. it seems like a more restrictive means. they will say, what do you mean we cannot give to who we want to give money to? toit seems to me fanciful
think that the sense of hasitude that an individual for a congressman will feel because of the substantial contribution to the republican national committee art democratic national committee. if any greater than the sense of gratitude and that senator or congressman will feel to a pac that is spending enormous amounts of money in his district or state for his election. i mean, it seems to me the latter is much more identifiable. there is nothing in the law that excludes that. apparently that is not too much of a risk. tojustice scalia, not here debate whether it is correct. >> it is what it is. >> we accepted. the line is that there is an
unacceptable risk of contributions when they are too high. your answer to the questions --t have been put previously that is the law. just to be fair. that yourtanding is answer is that it has been discussed. we can corruption is real and profound. if justice scalia's critique of the situation proves correct and it is deeply disabling for candidates and parties, congress can address that. if the court is having second thoughts about the , we could change that
part of the law. [laughter] >> far be it for me to suggest that you don't. >> the record, as far as i recall it several years ago, talked about at length -- i do not like to use the word corrupting. impacting the integrity of the process. stay corruption. it was about circumvention. i think he or kari right. -- i think you're quite right. aspect to this. with respect to mcconnell, it is a close parallel. really talking, they do not think about it that way. that is why i have been pushing this idea.
let's go into this, ok? go into it. >> i understand that, your honor. enacted, thewere same statute that the record pertains. it really does go to the same problem. it bears upon it. there is ample evidence that would justify it. i strongly urge the court to do so. thank you. >> thank you, general. three minutes remaining. >> thank you. a few points. thatve not heard them talk much about circumvention. that is because circumvention argument does not really work. it has been addressed by all of the measures that it contains. it is not sufficient. there are much more tailored ways. what we are dealing with is a
direction argument. will we accept the government theory -- conception -- russian theory the government is giving? -- corruption theory the government is giving? it is directly supporting one candidate and on behalf that candidate. their forcing money out of the most tense parent way to make contributions which is directly to the candidates and the parties from the pac. no further questions. thank you. >> thank you, council. the case is submitted. [captions copyright national cable satellite corp. 2013] [captioning performed by national captioning institute] case, theyafter the spoke to reporters outside the supreme court. >> good morning. my name is jim bob.
plaintiffs with mccutcheon in the case today. we did a brief on behalf of the republican national committee. we are very pleased with the results of the argument this morning. it is apparent that the court views these aggregate limits to limit how candidates a particular donor can support only nine candidates and only one of the three national political parties as a way to blunt of an instrument that causes first amendment harm. . we are very encouraged by the argument of today. we look forward to a decision by the court. it will help restore balance in our political system. right now the parties and
candidates are limited in what they can accept. donors are being forced to give money into super pacs and not for profits. it is much less accountable much less transparent than candidates and political parties and by forcing money to go in that direction. we have a less healthy system with these aggregate limits. we will see them raise more money. money rather than by the candidates and political parties themselves. thank you. >> hi. fred from democracy 21, one
supportingrneys for the aggregate limits. a couple of important points to make. scaliaf all, justice asked the question about how much money went to candidates and the parties and how much went to outside groups. -- candidates and parties with these overall limits spend $5.2 billion in the 2012 election. outside group spent $1 billion. candidates and parties spent 83% of the money in the election. party spent more than twice as much as outside groups. parties aretes and dealing with billions of dollars under these limits. secondly, this case is about million dollar and $2 million contributions. it is not about whether a femur
contributions can be made by mr. mccutcheon to humor candidates. it is about whether speaker boehner can set up a joint fundraising committee and giveit and mr. mccutcheon him money. it is whether president obama in 2012 will raise $70,000 contribution for joint fundraising committees could've raised money. this is about the kinds of contributions the supreme court .as ruled for 40 years creates opportunities for corruption and can be limited. facing the court is a question of whether they are going to throw out 40 years of supreme court precedent and declare unconstitutional a limit that prevents corruption. we see no basis for the supreme court to knock down these contribution limits.
on one other question raised by scalia. it was interesting. the supreme court declared limits on outside groups on constitutional because there is no risk of corruption. justice scalia seems to think that there is just as much risk of collection without said spending as are with contribution. that is not what the court said in citizens united. in citizens united, the supreme court said outside groups can make unlimited expenditures because they do not correct. they do not create opportunities for corruption. repeatedly court has said that contributions to createtes and parties do the opportunity for corruption and they can be limited. that is the issue facing the court today. this is a corruption case.
the supreme court were to strike down the over all contribution limits. we are bound to see billion dollar contributions solicited are the most powerful officeholders in washington and given by donors and creating opportunities for the kind of corruption that the court has said for for decades can be limited. thank you. justice seem to say it was just the individual limits, the limits an individual can give to a number of candidates. to disallow the aggregate limit or just that category -- for just that category? where is that like taking a break out of a house in the whole thing falls down? -- or is that like taking a brick out of a house and the
whole thing falls down? why shouldn't that person be able to give a few more attributions? there are a couple of answers to that. mr. mccutcheon could give contributions to every republican candidate for congress. he did not give $5,200 to each of them. the supreme court in early decisions have distinguished between the first amendment rights of a donor, which is in direct, and the first amendment right of the spender, which is directly. this is a line drawn by congress. they could certainly change that line. you cannot get rid of aggregate limits for candidates without creating the opportunity for speaker boehner or democratic leader a joint fundraising committee and solicit a 2.4
million dollar check for an individual. that is not crew -- true. >> will you let me finish? >> fine. but that is not true. >> as was pointed out in the argument, just as kennedy in the mcconnell case, supported the prohibition on soliciting large , he said that they created the opportunity for corruption. i go back. without this aggregate limit for party, president obama could have solicited $1.2 million contribution. without this limit for candidates, huge contributions could have been solicited for a joint fundraising committee.
that is why the court has her best to strike this down in this case. i'm david keating. , get counsel up here? -- can we get the counsel up here? murphy. m-u-r-p-h-y. the normal way. >> it doesn't make sense to continue to have these aggregate limits on how much people can contribute in the most transparent way possible, which is to the candidates and to the party and to the pac. as he told the court, it doesn't make sense to continue to have limits where somebody can contribute to nine candidates, but if it is 10, there is
something impermissible about that oh so we thought we had a great chance to make those arguments. the court asked wonderful questions today. of the argument, justice kennedy said, are you saying that we should go along with the system because it is the law? by the supreme court, it is the law. do you want that reversed? >> we do not think it needs to be reversed. we think these limits are unconstitutional under the current system. in this system, to impose impermissible barriers on people's ability to contribute to 10 candidates instead of nine and contribute to parties and pacs president making independent expenditures. there are some questions about the system itself. if the aggregate limits are
on constitutional because of the number of people you can give to people, why not the actual contribution limit itself? have beenimits justified on different grounds, grounds that have to do with a direct relationship between candidates and people giving them contributions. when you talk about a aggregate limit, you're not talking about how much someone can contribute to one candidate. you are imposing limits on how much someone can support. there doesn't seem to be a rationale for that institutional matter. >> it is about free speech. -- at the end of the day, if you win on this, you end up allowing people with more money to have more free speech. >> you allow everyone to have more free speech. your lap people to speak in ways that they find most effective and -- you allow people to speak in ways that they find the most
effective. allow them to speak by associating with people whose values they share and will put their values forward on their behalf. >> thing you expect what you think is the correct argument to coordinate? >> there are already restrictions on how they can coordinate contributions to each other. prevent candidates from giving large amounts of money to other candidates. >> what is the answer to what some of the justices said? if you win, that means more money for more people who have more money? it limits the voices of people who do not have a lot of money. amendment answers that we want more speech from everyone. it is not a question of who gets to speak. everyone can speak as much as they want to and in the ways
that they find most effective. the fact that they are doing so in the transparent way possible is in the system that we have with rules and everything else. about blake -- the public knows who is speaking. thank you. we come here from a campaign in north carolina. much of it is grassroots. lawyers are speaking to these issues. one of the things we want to make clear is that when we look at equal justice under the law, the law in all of its majesty wants to ensure constitution, that the homeless person has as much free speech as the wealthy person. this mccutcheon case would undermine that. put in seen this court
place by overturning shelby, a ruling that allows people unlimited ways to roll back forwarding rights and be challenge. i'm from the south. we are seeing that happening. we have seen the worst voting restrictions in the country. now they want to allow unlimited amounts of money to influence politics. in north carolina, we have seen that. we see the direct evidence of what happened when money influences who gets in our state capital and who gets in our government office. we have seen the connection between unseen amounts of money being spent and an attack on people who need medicare, public education, voting rights, the attack on the unemployed, staff tax policy.
for those of us at the grassroots level, we are deeply concerned that this mccutcheon case should not be named mccutcheon v. fec, but the real question should be money versus the people. will this be a democracy where we have equal justice? or will this be a democracy that is so -- sold piece by piece to the highest bidder? the moral issue in this from a biblical standpoint is found in isaiah chapter one. chief --hen leaders chaik and do not care for the , they undermine the nation. the supreme court would be undermining our democracy and allowing it to be bought and paid for by the highest bidder.
that would undermine the very majesty of the law. it was designed to ensure that the homeless person has as much free rights, free speech as a wealthy person. thank you. >> can you say your name again? reverend dr. william barber. i'm the president of the north carolina naacp and more monday leader. we found an amicus brief in this case. i want to make a comment on this case and correct a record that was set early. what these aggregate limits are about is that politicians in congress want to start challengers for them the funds necessary to mount an effective campaign against them. that is what this law is all about. as far as this idea that the joint fundraising committee will raise millions of dollars, the law already allows the speakers, the president to ask for over $4
million from political action committees and it doesn't -- , there is ahing limit on how much can be solicited by unelected officials. that is not challenged by this case. we think there is a good chance that the limit will survive. in other words, they will not be able to ask for these contributions. [inaudible] >> studies have shown that challengers rely on people like mccutcheon. people like mccutcheon and left leaning like to support challengers hear it as the chief justice said in one of his questions, what about someone who wants to support candidates who will support environmental
regulations are gun control regulation? he cannot support all of them. >> [inaudible] laws,doing need to have what we should do is have laws that are a scalpel that aims simply at the problem and not a meat ax approach that congress takes to start funding for challengers. example, an elected official could not ask for more than the current limits today. i think the law requires that now. a lot could easily be passed to target that. i guess i'm asking whether
the current scheme bars corruption or not? >> i think it keeps corruption in. need to get rid of the people who are corrupt. if you cannot get to a enough challengers, that will help them stay in office. the firsty we have amendment. speech is what is the check against corruption. speech by the press and speech by the people. thank you. hi. i'm president of public citizens. we also filed an amicus. case is about corruption, pure and simple. it is about corruption is people understand it. will it be more tilted for that millionaires and it is also about the way that the supreme
court to find a quote quote corruption. we will see more corruption. more legalized corruption will become the norm. if there is any doubt about how tos will go for billionaires evade any kind of suggestions are limits, look at the recent example of freedom partners. a couple hundred people will and together $250 million funneling it through secret organizations. this case is simply about corruption. to overturn this decision means to overturn the core precepts. hopefully they will decide not to do that.
>> putting money -- and there was an issue that was raised. this case could potentially put more money back into the hands -- instead of outside groups. >> there will be more money for the political party. it does not mean there'll be less money for the outside groups. the zillionaire spenders will write big checks as they need to. they will be able to do more. thank you. >> hi. -- we also filed an amicus brief in this case with a group of membership organizations representing nine .5 million americans who all caps together from the oldest and some of the largest member constituency groups in
that country, such as that ncaa cp, arp, all coming together. about bigare outraged money. in 10 americans say their elected representatives are more responsive to their big-money donors into voters are even the public interest. eight in 10 americans say large contributions are blocking our government from focusing on fixing the current issues that affect our lives, such as climate change, upward mobility issues. this causes the american people to have the lowest opinion of congress in historical record. it is critical that the court uphold the limits to be able to protect our government from even more big money. of the candidates elected to
congress last year raised more money from the 1% of the 1% and from all other small donors combined. i would like to rebut some of .he information being said that areport, we find big-money system is benefiting. the senate income is that over $7 million. also, we have to ask some of the aswe must understand american people do that these decisions do not get made and some kind of vacuum separate and apart from the other governing structures. we saw this in citizens united. they came to a decision. they thought all that money would be disclosed.
a turned up much of that money is not being disclosed. it led to an explosion in dark money. now return to go back through and fix the regulation after the fact. but the conversation to circumvent the limit and how all of those limits would play together, it was accepted by the lower court the contributions of over 3.5 million dollars would be solicited and that it would cause a corruption risk. in fact, if the court wants to look at such details, the real world impacts, they should perhaps question that in a trial court where they can build an actual record. really, this case is about whether our politics and policy in democratic government will be open for sale and able to be further captured i private
economic interests that are distorting our policy and that are causing the voices of the average american to be really absent from the public policy debate. government is so much more responsive to their big donors of the lower income folks that majority of the african american communities and almost a majority of the latino communities finding themselves in the bottom third of the income group. government has been found to be not responsive. there isn't a concert -- crisis. -- there is a real crisis. thank you. manon is bob. and with the nonpartisan research organization that does work in this area. there was a fair amount of confusion in the court about the mechanics of some of this process.
the movement of money can move -- my name is bob. i'm with the nonpartisan research organization that does work in this area. there was a fair amount of confusion in the court about the mechanics of some of this process. the movement of money. we know how transfers can be done. we will like to know how that will evolve over time. secondly, there was a question of whether the system we have really disadvantages the party. it would have destroyed their ability to raise funds because it lacked the ability to raise unlimited funds. but the party did well. they were active in raising small contributions. they have been able to raise
more money under the new restrictions than before. there's no reason to think that this provision needs to be overturned to protect the parties that have succeeded in the system as it exists today. were happy to have longer conversations is we need to to clear up confusion. >> hello. i'm the senior counsel at a center. the legal center has been involved in the case ever since the district court. we filed a brief in the district course. we saw again in the supreme court to explain the real world consequences of striking down the aggregate limits. how abstract and how many hypotheticals were proposed in the supreme court justices exposing how little they are versed in the realities of politics and the reality of the campaign finance. we try to point out exactly what would happen in the absence of aggregate limits.
ascame up with numbers such a single individual could give $2 million ton to the party of their choice. these numbers were not really in dispute. skepticism of whether this was really happening or whether it was a big deal. this is troubling. we could speak further on what exactly would happen if the limits were indeed unwound. towas very disheartening have justice scalia say over and over again why do we have to worry about every million dollar contribution but we have super pac spending $100 million independently? yource scalia, it was citizens united decision. it was unbelievable that he is now using that.
as a justification for striking down debt and another protection against big money in politics. argument exposed how far the judges would do -- go. i will be happy to expand further if there are further questions. thank you. >> good morning. my name is stephen. i'm a staff counsel at common cause. common cause signed off to a brief that was authored by the campaign legal center. it was standing up for average, ordinary americans who are tired of their voices being drowned out by big-money. we have a lot of problems in our politics today. a lot of dysfunction. look at the government shut done. some are some who thinks of the problems is that there is too little money in our politics. that is something that we reject at common cause.
the supreme court has rejected it for over 40 years. thing that stands between integrity of our representative democracy and a system of here in utter legalized bribery are these contribution limits. promote the first amendment. contribution limits ensure that we have a vibrant democracy and folks are able to express themselves on the basis of their ideas and out by the death of their pockets and by the size of their bank accounts. the american old have been --ling the representatives the american people have been calling their representatives to make clear once and for all that money is property and not speech . corporations are entities that spur the economy, but do not have the right to spend unlimited amounts of money in politics. i'll be happy to talk about what is happening at the grassroots
level here you -- level. >> here i am. i'm in chicago. married. 1977. i have my bachelors degree. you think they would be looking for young, bright, articulate people like me to work for your firm or company. no. one application after another. i thought to myself, i did this in college. i drove a cab. i have to tell you, it was hard. i was driving a cab with so many plans. i remember when i went back to see my dad. he said after all of the effort and all of the expense for you to wind up doing exactly what i and i said, dad, it is a stage. i have to work and keep my self- respect and dignity. this is something that puts food
on the table and pays the rent. gutierrez.man luis span 2. "book tv" on c- 1998 on weekend since the c-span 2 book tv has featured top nonfiction authors. >> i thought, wow. that is the answer. more women in politics. if we had more women in power, things would change. i thought why not write a book why women should rule the world. she said, ok. being ignored by the elite media, not getting any special interest help in washington, we are all in the same boat and a matter what color we are. that is the real problem. >> the only national network
devoted to nonfiction books. we are marking 15 years of book tv on c-span 2. houseare at the hoover here on the campus of stanford university. this was a primary residence of the hoover's. such a strong grasp of design and how she wanted the house to look even though she was not an architect. we're lucky to have a lot of original drawings and documents and correspondence relating to the design and construction of how she wanted the house to look. influence came from her travels in the southwest of the united states. she also had travels in north africa. .t is a great legacy she designed the house and
created it. it was inspired by her ideas. involvement in all aspects of the houses creation. lady, mrs. first hoover. >> next is a discussion on the health care law's implementation. journal."n host: nancy-ann deparle is joining us this morning. she was the white house office of health reform director from 2009 until 2011. she is currently a -- welcome to the conversation. thank you for being here. guest: thank you. host: let me start with your role and affordable care act. what did you do when you were at the white house?
guest: mainly i went up to capitol hill. to president decided not draft a piece of legislation and send it up to the hill. it might have been the easier thing to do. in order to make sure all members of congress had an opportunity, he asked congress to draft it. there were five committees of congress. three in the house. two in the senate. they worked and each passed a version of the legislation. we work with those committees as favorite in the drafting. one thing that is important to about how ite talk began. it ended with president barack obama. that is not the case. theting with the end of clinton health legislation and health security act in the mid- 90s, there were bipartisan efforts going on from that
forward to work out what the problems are that we need to fix. what our solutions? there was considerable bipartisan consensus setting up market laces and requiring everyone to have insurance. make sure people with pre- existing conditions cannot be blocked out. controlling costs. make sure they work in a bipartisan way for almost 20 years. that is where congress started, with the work they have been doing. to craft a bipartisan solution. focusre has been a lot of on the marketplace exchanges. a start up tober one. who came up with the idea? how did it, but? -- how did it come about? 1990's when people
were looking at why the clinton bill did not work. what are things we need to do to make a solution and get everyone covered in this country and bring costs down? the idea sort of originated in that time. the best news was that it was not just an idea. we have a model. and what the state of massachusetts did to try to cover all of its residents. it has been quite successful. in the state of utah, they experimented with the same thing. idea. an one thing that is in porton to remember as we watch the isketplaces, the marketplace designed for people who do not have insurance over the
relatively small group american to buy their insurance right now through what is called individual market. they do not have insurance through their employer. they go on their own to buy insurance. that individual market is something that has been characterized by very high rates , the ability of insurance companies to deny coverage if you have a pre-existing condition, which many people do, or to charge extremely high , age rating were people who are older are charged more, gender rating, women are often charged more and often more. that was the market that people were trying to fix. there was broad agreement that that market is broken. that is a market that these markets are replacing. is a separate market called the shop exchange that is being created for small businesses.
it is for those people that these mark its art opening up. there is something of a feeling out there for everyone here at everything is changing. i have to go to these markets. that is not the case. if you have employer-sponsored insurance, you can do that through your employer. if you have met the requirements, you do not have to do anything else. endurance becomes more secure. you have benefits such as -- if you have a pre-existing condition and you want to go out and started business, there will be a place to find affordable coverage. you do not have to go to the new marketplace. if what you see now -- nine host: is what you see now what you envisioned when it was put together? guest: the cusp of our experience -- the customer expense is not what they want yet. they're working to make it better.
there are a number of insurance plans offering plans in these exchanges. coming to onerson of the marketplaces will have a choice of at least two carriers, to insurance plans. that has not been the case in many parts of the country in the past. as 100 cases, as many plans to choose from. that is what it marketplace is. offering lots of different choices to consumers. that is something the framers wanted and that the president wanted. that kind of competition. that is one thing. prices being charged, what we hoped in a marketplace where plans are competing on price and quality of or all of that is transparent, their choices.
the premiums would come down. the premiums that are being offered in these exchanges in the marketplaces so far around 20% less than what the original budget office projected that they would be. why is that? we know competition works read having transparency -- we know competition works. we know transparency works. they want to be in their. they are being very aggressive about getting good prices and offering good prices. that is a great thing. the markets have read about in oregon, some of the insurers after turning in their plans for their premiums, they came back and asked to lower them. wassouth the competition offering. that is what we need to bring for uninsured americans. host: what about the two things
that are working the exam -- exactly we hoped question mark -- what about the two things that are working exactly the way we had hoped? >> this is unprecedented. it is very hard. the experts have said this kind of effort would tax the best minds at the best technology companies in the world. it is tough. -- the third thing that is working so far in the way that we had hoped and were not sure that it would is that people are really interested. that we would be able to attract a lot of people to find out about these exchanges. there's been a lot of news over the past two months that 40% of americans have never heard of it. they do not know that insurance reform is coming.
it is here. .hey are voting they are interested in it. that has taxed the system. -- they are expense working around the clock and have made improvements. it is getting better. people, theyured can compare plans and figure out what they want to do. december 15 a sign up for cars to begin january 1. coverage to begin january 1. there are friends who told me they have gone online to look. they have insurance are ready. there's a lot of curiosity. with we are speaking nancy-ann deparle. health reform director from 20 -- 2009-2011.
bilking on twitter wants to know this -- will the aca have universal care for all? it is built upon private sector plans and the private sector model of getting insurance. that is why these new marketplaces deal -- are there to help people who are uninsured or who purchase coverage through the individual market today. universally, people would agree that insurance and everyone in that market would agree it is broken. doesn't work well. you have to have everyone in the system. -- afford in short insurance, go in there and buy it. if you can't, purchase a plan that help from the government in the form of tax credits and subsidies.
i do not think it leads to single-payer. it strengthens the american system we have here in -- that we have. host: on twitter -- guest: first of all, i want to be sure what is looking at is the same high deductible plan he has before. there are plans at that minimum actuarial value that will be offered on the new exchanges. if he has one already, i am sort of wondering if you can that individual market or says he is getting it from his employer. i don't know why it would have doubled from his employer, but i can tell you in the individual market where people are purchasing these or high
delectable plans, the only reason why it would have increased is because you're getting better coverage. you can no longer buy a policy that doesn't cover hospitalization. if you are a woman, i was just with a breast-cancer doctor here in new york who said he was trying to find help for young woman who purchased or who has breast cancer. unfortunately, she is come to see him. she thought she was ok because she had insurance but it excluded breast cancer. there will be no lifetime limits, so people can't go bankrupt because they have a huge medical bill they weren't expecting. there are things that were done to strengthen the insurance that people get, and that might have increased the premiums lightly, but it should out of priest it that much. i went encourage them to call the interest apartment north carolina who might be able to answer that question. host: elizabeth, independent caller. caller: you did clarify some of the logistics.
my husband is a small business owner and our premium if we go on the exchanger, $658 a month, which is not unreasonable for our coverage, but it is unreasonable because i am and my 22-year-old son is underemployed. before, yes, we were uninsured. my son was insured under the state of illinois. i am disturbed because i don't want to be a burden of the state. it goes philosophically against my grain. i am looking for jobs night and day, full time for insurance. i keep wondering, how many people, especially also in the south where i spent time with my elderly mother in some of these dry injured states, how will
they be able to afford it? and there are result differences. we have more competitions and some of these northern states but these southern states, i think that is where we are getting a lot of the friction. i don't think there are enough insurance companies to keep the competition. what is the timeframe that you think this is sustainable at the family level? two years, three years, four years where we're not borrowing money from overseas and putting our country even more in debt to foreign countries. guest: first, i appreciate your concerns and the president was concerned about some of the same things, which is why this law is fully paid for. was very difficult, but he insisted and the members of congress who are leaders on his insisted to be fully paid for, unlike things like medicare part d benefit was not paid for. this was paid for through savings in the health care system, which meant, for example, hospitals will have lower reimbursements to cover people who are uninsured. right now there are payments made to hospitals to cover the
cost of people who are uninsured. the theory was, once people have coverage, hospitals won't need to get as much reimbursement for uncompensated care from medicare. those things will reduce and there were many other changes made to save money. this law not only didn't cost additional money, it actually saves money. so far, i would have to say in response to the question, it is working even better than we had hoped. when he asked what is working and what is not working, right now health-care costs are increasing at the lowest rate in more than 50 years. the economists who have looked at as a part of it is because of the recession, as our caller is talking about. people have cut back because of lost jobs or are afraid of losing their jobs. part of it relates to the other letter about a high deductible plan. i think most economists think having consumers have more skin in the game has also to help lower the rate of health care
cost growth. economists that i've seen that look at it like david cutler have concluded more than half of the reduction in cost can be attributed to the changes in the affordable care act, to the things that are helping to bring down costs and lower costs. and these marketplaces are going to be a part of that. they are offering premium packages to people that are lower than what they would be facing today if they were trying to buy insurance. hopefully, that will help the caller with her insurance needs going forward. we have seen more robust enrollment already. we have seen plans injuring --
even in the southern states, i would have expected perhaps to see less competition there, fewer plans, and we have seen more. for example, texas. the premium rates down there are going to be quite good in some of the areas of texas, in part because there's a lot of competition. the plans are eager to come in and try to get those uninsured and insured. i think it won't be three years you'll have to wait, extra think you'll see better rates. host: what about the role the medical device tax is playing in supporting the affordable care act and allowing it to be paid for? a lot is made on capitol hill about whether to repeal that tax. why was that put into the legislation, first of all, and what impact could that have if it is removed?
guest: well, when the legislation was being developed, and this is in the senate finance committee where the finance committee both did the authorizing legislation for the various pieces of the plan, so the marketplaces and the tax credits and subsidies that make this work, but also paid for the law. that is part of the responsibility, to come up with ways to pay for it. the president and members of congress and the senators felt strongly that it had to be paid for, that they did not want to add to the deficit. so the theory the committee had, and this was a bipartisan -- them committee was working on a bipartisan races for really more than two years on this, was that all parts of the health care sector would benefit from having every american having coverage. and being required to have it. so you're not earning other people, as the caller said, by showing up to the emergency room and not having coverage and adding to the premium cost of other families. the theory was, every part of the health-care sector will benefit from the so every part of the health-care sector should
help to pay for it. so as i mentioned, the hospitals will have lower reimbursement for what is called uncompensated care, charity care. the theory is, their reimbursements will go down, they will be getting people coming in the door with coverage and that will help to balance that. similarly, first -- pharmaceutical copies were required to pay an excise tax in essence to help cover the care beneficiaries to make sure the so-called doughnut hole in coverage under the part d benefit was filled. right now beneficiaries have faced this hole in coverage or they get to a certain point and their drug utilization and not covered anymore until it gets much higher. for many seniors, that meant they just quit taking the medication, which is not good at all for them or the health care system. pharmaceutical industry was required to participate. every part of the health care sector had some participation in this. and for the medical device industry, what they came up with the was this notion of an excise tax. in the finance committee, i believe it was $40 billion or $50 billion over 10 years. by the time he got to the senate floor, it had been reduced to
half that, i think around $20 billion. the device industry and the devices they sell in the u.s., this tax would be applied. as you mentioned, working for three years now to get that repealed. the problem with repealing it is, first, the principle that everyone participated in, which was that all parts of the health-care sector are going to do better and have more reimbursement coming in the door through the fact people are being required to have coverage. and secondly, if you start repealing parts of the law that helped pay for the law, then you have the problem that the caller mentioned a few minutes ago, which is that this becomes a program that isn't paid for, that adds to the deficit, which is something members of congress and surly the president what --
don't want to do. host: a lot of people lining up to a lot of questions about the affordable care. ron, illinois, republican. caller: i have to take issue with her comments about the bipartisan nature of the bill. as i remember it in march 2009, the republicans try to schedule a time with the president in the white house to begin talking about this bill. they refused. they were not allowed to come. also, i would see -- i think it was senator sessions on the business channel saying he had tried to call, written letters and would never get any response. if i am remembering correctly, the only republican idea that was adopted in this legislation was one that came from the february 2010 meeting when, finally, the president sat down with republicans to talk about the bill after it had artie been voted on and passed.
and they decided they liked the republican idea about secret shoppers. is there any tort reform in this bill or anything else that was a republican idea that was incorporated into this bill in a bipartisan way, by any republican? >> host: nancy-ann deparle? guest: there are a lot of bipartisan ideas. the senate finance committee worked for two years before
2009. there was a white paper that chairman baucus and the ranking member of senator grassley put out, literally, the day after the election in november 2008 saying, here is our white paper, here are the things we think should be in health reform and included the marketplaces and tax credits. it had a question mark about the so-called public plan, because that was very controversial. it had medicaid expansion. a lot of the central ideas that ended up in the health reform bill were worked on over a long period of time on a bipartisan basis. even up to the senate finance committee's markup of the bill in the fall 2009, march 2009, which are bringing up as a time when republicans were not invited to the white house -- gosh, my memory couldn't be more different. i started on the job in march 2009. my first day at the white house -- even before i started, the president asked me to come down because he was having a summit at the white house. it was a full afternoon there. there were dozens of republican lawmakers there as well as democrats, as well as other stakeholders from the hospital industry, from the pharmaceutical industry, various others, consumers, who have an interest in trying to do something about the problems we were facing with our health care system.
if there was an effort to not listen to or exclude republicans, i sure didn't get the memo. i spent hundreds of hours myself going from office to office on capitol hill, meeting with anyone who would meet with me, meeting with some of the republican leaders multiple times. really, we had constructive conversations and did include a lot of their ideas. i am thinking of one of particular that came up the other day, senator grassley had a lot of concerns about transparency of prices and costs that people have the health-care system. we agreed on that. there is a provision in the law that requires hospitals to publish the rates of the most frequently used chart medicare charges were hospital billings, at least on an basis. that information was put out for the first time for thousands of hospitals across the country. that was senator grassley's idea. i have to give him credit. on medicare -- it was not just for medicare, he wanted it for everything, but we haven't had that information -- cms put it out because that is what they have.
he wants hospitals to put it all out more transparently. it is a good idea. there are many ideas that senator olympia snowe have. for example, she wanted to make sure that small businesses received some tax credits to be able to help defray the cost of coverage for their workers. and there are small business tax credits, millions of dollars of them, because that is work that senator olympia snowe did, who is very concerned about small business. there are dozens of republican ideas in here. if i have one regret, it is that people do have the impression that this caller has, that the president did make a big effort to reach out and work with lawmakers on both sides of the aisle, because he really did. i saw that. host: a couple of tweets for you -- guest: first of all, remember, this marketplace is for the relatively small group of people who purchase their insurance
through the individual market. we are talking 10 million, not 150 million. the vast majority of americans who get coverage do so in the commercial market. in other words, not through medicare or medicaid, get it to their employer. that will stay the same. secondly, the marketplaces are disposed to be enrolling people yet. they are open for enrollment. but what we expect his most people are going to want to go on and look, compare their choices, talk to friends, and really make a reasoned decision about it. some people have enrolled. we know that because, remember, some states are running these exchanges are marketplaces on their own. in techie has announced a already have -- kentucky has announced they already have a few thousand people enrolled. some people are making a
decision and enrolling. but they have until december 15 to get coverage that starts january 1. under the law, the open enrollment will extend until march, the end of march. they really have six months to get this done. if they want coverage to start january 1, they need to be enrolled by december 15. i think it is too early to pronounce this a failure. i think i many of the important qualities, it is a success. if i could respond to the first tweet about risk. yes, it is true, some people have more claims than others. i'm not sure -- i'm not an actuary, so i won't make a pronouncement about who that is. but the weight employer sponsored insurance works is, it when you have a broad group, you spread the risk. so one person doesn't have a much higher premium than another
person just because they happen to be a woman. it is true women use care, use maternity care. that is a fact of life. but this law evens out those kinds of differences so that women aren't charged more than men so that older people can be charged more, but the amount of age rating is limited. it is not 50 times as it was in some states before this law was passed. that enables everybody to get coverage, which else everyone. host: dorothy, baltimore, independent caller. caller: i have a couple of things to say. i got a $20 rebate on my co-pay
when i go to the clinic and all that with insurance from my job, and i did get two checks back. that was great. it wasn't a lot, but i didn't have to pay it, so it was great. but one thing i want to ask you, i hear people's saying about the insurance going up. they can't be an exchanges, because they just came up. so these would be outside insurance companies, not exchange insurance companies. i wanted to say something. is this is going to work, if exchanges make the prices lower -- which the outside company not in exchanges, if they want to be competitive, they're going to have to try to compete. so i am thinking -- this is just my thinking, but the insurance exchanges to my once they get up
and people -- people are looking , shopping. if this lower, and i just changed jobs, and if it is lower, i'm going to take exchanges because we have a choice at this new job whether to take there's -- i guess i could pay whoever i wanted to. it is not mandatory i take it. this is what i'm thinking. that those exchanges, and once we start getting into it and people see the prices, the other insurances that went up are going to have to come down where they will lose customers. guest: i think you may be onto something there. first, on your point about the rebates, that is another provision of the law that was added, which is to require insurance companies to spend at least 80% of your premium dollars on actual medical care as opposed to administrative
costs. and because of that provision of the law, millions of americans have already received rebates like the one you talked about from their insurance company. insurance companies are being more careful about the premium increases they put into place because they don't want to pay those rebates. i do also think the expense of the marketplaces having an impact on the rest of the market , and employer-sponsored insurance. the reason i say that, there are
private sector companies that are starting up exchanges or marketplaces for large employers. large employers right now can't come into the exchange of purchase coverage on behalf of their workers, but they want the same benefits of having more transparency, of seeing panic -- plans competing. some of the large employers are going into these so-called private exchanges where they will purchase insurance for their workers alongside other companies. i think the principle at work here with the marketplaces that are being set up by the federal government and by the states will also work in these private exchanges, which is that were transparency, competition on price and quality is going to make a difference.
it will bring the cost and the prices down. host: people have heard, for these exchanges to work, it is dependent on young people to sign up. the number thrown out total is 7 million is what the administration is aiming for that will sign up for these insurance exchanges. and that 7 million figure, how many need to be young people in order for this to be successful?
guest: i don't know the answer to that, but let me give some color around the 7 million number. that is in year one, that is the estimates on the actuaries needed to make these exchanges or marketplaces work, is that they get around 7 million people enrolled, and that is what the administration is protecting. the congressional budget office rejected a similar number. i don't know what proportion need to be young and healthy, but i do know the way this works is the young and healthy people use less coverage i'm a so their premiums help to defray the cost for the older people who have more conditions, presumably, and that is what makes the insurance
market work. that is why large employers are able to get better rates, because they can spread the cost among a lot of people. so that is the principle behind it. based on interest we have seen so far in getting signed up, that all goes well for having the kind of robust participation that is envisioned in this thing. host: recently written in a magazine, the question is and how many people in role, but what kind of people enroll. two thirds of the uninsured in america are under the age of 40. what will be the average age of an enrollee on the exchanges? if most were born before or during the nixon administration, start worrying. guest: well, i agree. avik has written very smart articles. for three years we have heard it whenever happen, congress will appeal it, supreme court will strike it down.
it is happening now. the good news is, we can look at the facts as opposed to projections, so we will see. so far, things are working quite well. as i said, although i know they're not satisfied with the customer experience of the first week, i am proud of the work my former colleagues at hhs have done over the past three years. there are people there who have worked with me when i was running cms back during the clinton administration, people who work with former secretary leavitt who is going to be on in a few minutes, and helping them to get the medicare part d benefit set up. these are tireless professionals who are working to try to make this a good customer express for the american people. i give them a lot of credit. host: the opinion section of "usa today" -- kathleen sebelius says, engineers are working day and
night on upgrades to cope with the high demand. claremont, confident, republican caller. caller: good morning. i can't believe some of the b.s. being put out here. to take a young guy who doesn't have any money in the current economy, i mean, there are so many reasons he is not going to pay for it when he pays on a blondes -- bronze plan and will have a $4000 or $5,000 deductible is going to have to pay $7,000 before he gets any benefits.
and they're going to try to say, instead of buying a football jersey or that tank of gas so you can take your girlfriend out for dinner, instead of trying to get something, we have to put up with the government telling people where to spend their money. by the way, pick up some maternity care and every thing else. the photo op obama had with the gluttonous people behind his gluttonous idea of spreading the ever-increasing government, more more stuff that you spent and you're getting the special sweetheart deal where you leave the white house, there is this revolving door were you go over and make a big goal sugar daddy -- bagels sugar daddy salary, just like all the insurance companies who set this deal up, it is a big fiasco. as soon as the young people see it, you guys are in for such a big surprise in that election coming up in 2014. it will be a wonderful time. >> there are two parts. on the policy side, him doubting that young people will sign up with a don't have a lot of disposable income. guest: first of all, the young man he is talking about, let's break this down. if he's younger than 26 and his parents have a plan, under the
law, he can stay on her plan. if he's older than 26 and he has a relatively low income, he will get help with purchasing a plan and it will be $171. i don't wear member with the numbers are but a bronze plan is very inexpensive. or you can buy what is called a catastrophic land. for your he -- a very young people under 30, they can buy a catastrophic plan that will just afraid the cost of a major hospitalization.
what i found in talking to young people is there are some that have the opinion that the caller had, that they feel invincible and don't think they should have to buy anything. many of them, though, say they want coverage, that they just did understand it, didn't understand if they got hurt in a motorcycle accident or broke their arm or leg playing soccer that they would then impose a cost on everyone else. when they show up the hospital, the hospital has to treat them, and that adds to the cost that everyone else pays. the estimates are that families who get their coverage through work pay premiums that are in average of $1000 higher every year to pay for this cost of an, medicare for those who show up at the hospital without coverage. -- uncompensated care for those who shop at the hospital without coverage. people expect this is something, this is part of my job as a citizen, to make sure i have coverage. if i can't afford it, if i am someone who can't afford it, i will get help. but if the young person is someone making a good salary, they should be expected to contribute to that. host: nancy-ann deparle, i want to point out for our viewers, this headline. california throws its weight behind health care law. it is a state were 15% of the nation's uninsured live. a lot of resources being poured into implementing the new system in that state. on the second part of what the viewer had to say i'm a robert simpson wants to know about your current position. guest: i just started with confidence in september, the day after labor day.
it is a start up, a new firm, investment firm. this is what i did when i was out of the government before. i came and helped on the health reform law for the president and spent four years working there at the white house, and now i'm back doing what i was doing before, which is helping to start out care companies. host: troy, new york, democratic caller. caller: good morning, ladies. i would like to give out some information that i got from c- span, because there's a lot of misinformation, especially near opening segment. you guys have a series on every money for but the past month -- host: there's a kaiser family foundation and the health news, separate, independent entities. go ahead, try. caller: and blackhealthtv.com, there is another website. there are some interesting facts about obamacare. one thing i want to put out to my right-wing friends listing right now, wall street has plans to make a lot of money off this insurance. if they weren't going to make that much money, so why are so many insurance companies planning to spend $2 billion on advertising? another thing -- host: one at a time. let me have nancy-ann deparle respond to profits will be made from the affordable care act. guest: i think they will. we are building this on the private sector her. the system is built on private health care plans, not the
government taking over health care. there are private insurers who will cover more people. the insurance markets are being reformed so everybody can get coverage and you won't get locked out if you had a pre- existing condition. it should be profitable for firms who know how to provide good coverage for americans who haven't had it. host: nancy-ann deparle, thank you for your time in talking to our viewers. guest: thank you. host: our conversation will continue to miss speaking to former utah governor and hhs secretary michael leavitt. then we will talk to the national parks conversation -- conservation association. >> were in the partial government shutdown. it is also taking a toll on the white house, according to the associated press, were they say three quarters of the staff is being kept off duty. usually there are more than 1700 advisers, assistance, chefs, and landscapers working at the white
house but with the shutdown, there are fewer than 450 on the job. president obama is at the white house today and instead of attending the asia-pacific economic conference, secretary of state john kerry is at the meeting and the president's place. where earlier today secretary kerry met briefly with the leaders of russia and china to discuss the situation in syria and other world hot spots. an american official traveling with secretary kerry says he spoke with vladimir putin for about 15 minutes in a conversation that focused primarily on organizing an international conference to help syria create a transitional government. the officials said they agreed on the importance of organizing the conference by mid-november target date set by the united
nations. congress is in session today. chambers can meeting at -- convening at 10:00 a.m.. the associated press reports that oklahoma republican senator jim inhofe underwent an emergency quadruple bypass last week and doctors haven't yet given him clearance to fly. kerry met briefly with the the senator, who turns 79 next month, tells the ". world," he feels fine and never expressed any symptoms. the problem was discovered during routine tests. he expects to return to washington in a few days.
>> the c-span archives are amazing. >> the video library is amazing. you can view and share c-span programming any time. it is easy. >> the c-span video archive is the true modern record of congress. c-span archives are amazing. >> the video library is amazing. you can view and share c-span programming any time. it's easy. here's how. go to c-span.org and go to the video library to watch the newest video go down to the most recent, click on what you want to watch, and press play. you can also search the video library for a specific topic or keyword or you can find a person by typing their name, hit search, and go to people.
go to their bio page and scroll down to their appearances. you can also share -- >> "washington journal" continues. host: our conversation continues on the affordable care act. michael leavitt joins us. the former hhs secretary under the bush administration from 2005-2009. many have compared the affordable care act, the rollout of a, to medicare part d, of which you spearheaded. what was your role in that? guest: as secretary of health, i had all responsibility for its and limitation. i would have done the same thing at this point that kathleen
sebelius is doing. obviously, there were tens of thousands and in some cases hundreds of thousands of people involved in it. my job was to oversee it. host: what was the goal of it? guest: to find and educate and enroll 43 million americans in the course of just a few months. it was a significant challenge in the same way those implementing the new health care law have to face. any similarities, but a few differences. host: it when in effect in 2006. a proximally 50 million elderly and disabled beneficiaries have access to medicare drug plans approved by the federal government. this information according to cms and the kaiser family foundation. how did you prepare for the rollout of medicare part d compared to the rollout of the affordable care act? guest: both require many many months preparation. we had roughly 18 months to prepare for the actual enrollment period they're going
through now. there were systems that had to be cord needed. nearly 50 medicaid systems coordinating the computer systems. or was entire country to educate. we had to work with plants in the same way this new benefit is being coordinated so there were plans available. it was a massive logistical, and am i say, social logic exercise to bring about an entirely new way of buying insurance to a population of americans who badly needed it. host: what are the lessons learned from the rollout of part
d that are germane to the affordable care act? guest: primarily, the early preparation would pay off. as i look at what is going on currently with the implementation, i think we are seeing some of the same things we experienced early problems, because this is a very complex set of issues. the current administration made a decision that they would, in essence, to for making many of the rules or announcing many of the roles that would government during the election. it put them a bit behind. therefore, the level of testing and were able to do was not as robust as i think they would have liked it to be. and the consequence was in the early days of his rollout we are seeing some systems problems. i think they have substantial amount of time still to make
that work. the way the program works, ultimately, the big and quite heavy implementation period i think will be in mid-november through the end of the year. they need to get it right between now and then. what we saw was essentially, what should have been a dress rehearsal or were they should've had a dress rehearsal, the opening night really became the dress rehearsal and now they're having to scramble to fix it. host: in your opinion, is there time to fix it? guest: i think there's time.
they have now until january 1 when people will gain coverage. obviously, we don't know the depth of the difficulty they're having. there's not much information about that. what we do know is many people tried to get on and could not. there is nothing truly unusual about that kind of thing occurring with their brand-new system is big and complex as this one. we will see how they do. obviously, they have teams working on it. and they will do all they can to make it come up. if they don't have it fixed, i would say, in the early part of next month, i think their problems will become more severe. host: in july of this year, you wrote in a piece for "washington post," were you laid out risks to implementing the affordable care act. you put down insufficient education, technology breakdowns, subsidiaries, and finger-pointing that could all lead to risks to the health care law. where are we now here in
october? guest: those four items were lessons i had learned going through the experience you alluded to earlier. like the current administration, and entire country had to be educated. early on, not many people knew about it. as is beginning to occur, the news media is focused on it, other people's word-of-mouth is beginning. putting insufficient effort to build the infrastructure to do that was a risk to them. i still think it is a risk to them. they have nearly 10,000, what they referred to as navigators, people who are assisting others to know how to operate the
system. many of those people are inexperienced. they will gain expense as time goes on. the systems risks i have already alluded to. i think there'll be additional problems as we get down the road they're going to have to work out, some of which will be involved in the subsidies that are available to people who are in certain income categories. that is a very complex system and we have yet to see operate at a full level. the last risk of finger- pointing, a lot of sociology is involved. people naturally point at others. they need to have good partnerships with the insurance plans and states and others without those partnerships -- without those partnerships, they won't give to do what is so important in making this a success. that is good problem solving and coordination. host: let's be clear, do you support the affordable care act? do you agree with the law? separately, do you agree with the republican strategy on capitol hill to try to defund it or delay it? guest: i did not support the affordable care act. i do support the need -- i think while he held aspiration for everyone in our country to have access to affordable health care plan. there were many aspects of the president's approach i disagreed with. it is the law of the land and people are implementing it and we're all having to do with it now. that is where my efforts have been focused. congress is obviously playing out a political process. in my mind, it is not about whether people ought to have insurance, but whether or not our country can afford the level of subsidies in the context of a large national budget problem that we obviously have. that process is ongoing and playing out. like most americans, i'm having no influence on it but watch it with interest. host: michael leavitt, former governor of utah, served as president bush's hhs secretary, spearheading the medicaid hard d -- medicare part d. he is also an author of a new book. independent color, first out. caller: i'm wondering if the affordable care act works as proposed, will it have an effect in reducing the cost of medicaid? guest: first of all, pam, the affordable care act at somewhere
between 15 million additional people and 16 million additional people. i think it will be less than that because a number of states have chosen not to take the option of implementing it, primarily, because of the cost. it would be difficult to say medicaid would be reduced as a matter of expense. that is a great problem in most states because the money say go to pay for medicaid also compete with other important things like public education and higher education and building of infrastructure. states are struggling right now with the way -- weight of this and i suspect that will be an ongoing debate. host: michael leavitt, a tweet -- guest: that is an old discussion that came up at the time. they believe they're going to implement it, then it needed to have a physical pay for, as they say in washington -- fiscal pay for, as they say in washington. i was not actually there when it passed. my job was to implement it. i'm not as conversant on why they did or didn't. the truth is, we have a very serious budget problem and there have been actions by both parties that have contributed to that. the impasse we're seeing right now, in my mind, is not a question of whether we have a problem or not, but whether we are going to deal with it. both parties contribute it, and both parties need to be taking part in solving the. host: nancy-ann deparle said it is paid for. what you make of that? guest: nancy-ann deparle is a very good friend of mine and there are many things in the world we agree with. in terms of budget scores, there was a plan to pay for it. the reality is, it was paid for in large measure -- a majority by a group of medicare reductions that have not yet occurred. pardon me if i seem skeptical about whether or not that will actually occur. we will see people are not inclined to have their medicare benefits reduced, so we're going to have to see if another plane comes about. you can mark me down as a bic skeptical. host: another tweet -- sandra, indiana, independent
caller. caller: good morning. hello? guest: good morning. caller: it was brought to my attention this week about the hhs in conjunction with the cps, if you are ruled a high risk under the exchanges or the obamacare, they can go into your home at any time and check on your children. and if there is a weapon or alcoholic beverages or if you smoke, they can take your children from your home. is this true? guest: sandra, i don't think that is true under the affordable care act. there would be state laws analyst every state that would protect children when there are situations in their lives that put them at risk. but i know of nothing and felt confident there is nothing in the affordable care act that would either change what is going on with states, or for that matter, bring that kind of worried to bear. i think the state governments are the ones that pass those laws and enforce the care for children. i wouldn't spend a lot of time worrying about that if i were you. in terms of the affordable care act. host: tony, democratic caller. caller: good morning. you guys are doing a great job on c-span. i hate to be the conspiracy theorist here, but isn't it possible that we are having so much trouble with this website, isn't it possible that someone is flooding the site, you know, if you get too many people on there, obviously, nobody is going to get through. we all know the koch brothers and other organizations are finding people that go on these bus tours. i think a lot of the republicans are funded by these people, too. it just seems to me, if there, stop these thing -- this thing, it would be a good way to do it. guest: that is an interesting theory. i think it is not likely. i suppose it is possible. if that were true, it would be in violation of the law and i'm sure it would be detectable by those who are managing the systems. i have heard nothing of that sort. so i would guess on balance it is likely not true. but thank you for calling. host: guest: that is consistent with my understanding.
host: can you explain that for people who don't know? guest: the question is, how does a person who was not familiar with or may not have access to the internet, how do they access information? i think, naturally, the administration has sought many different channels for that to occur. it is my understanding that those who are in the business of providing intermediary or help to the consumer are able to register and become what i referred to earlier as navigators, and they can, in fact, be compensated by the government to help consumers work their way through the system in the same way they would help consumers work their way through the private system. host: a lot of attention paid to the website healthcare.gov. jim on twitter --
guest: i suspect because it is a very low number. i don't mean that as a criticism. i think the way the program is structured, the system does not accept payment, therefore, they don't get insurance until january 1. i think what we will see is most people during the first several weeks of this and limitation are essentially windowshopping, trying to figure out what it would mean to them. i think if we didn't know that number, it would be underwhelming, simply because most people are windowshopping. host: robert on twitter -- guest: well, i think that is the way it was ultimately sold, and to some extent, it may be true.
there is a lot of pressure right now on doctors and hospitals to provide care for lower-cost. let's acknowledge on the surface, that doesn't feel like a bad name, and lesson becomes so difficult to find a medicare physician, someone who will take medicare patients, and that gets harder every year. the more pressure that is put on the system. again, i think, frankly, hospitals more effective lobbyists than consumers on a one-on-one basis, so you can still keep me in the skeptical: as to how many of those reductions that were used to pay for the affordable care act will actually incur. host: what is your take on a medical device tax, the 2.3% on all medical instruments, with some exclusions?
there is talk about repealing that part, with bipartisan support. what do you think about that? guest: i think the reason there is bipartisan support growing to repeal it is because in very real ways it is a tax on consumers, because it is passed through. the second is, medical devices and pharmaceuticals and others, while there are thought about as big corporations, they employ tens of thousands of people. we have put at risk of very
important group of industries by imposing it. we have actually just taxed people who maybe can at least afford to pay consumers by causing them to be paying more. we have also hurt the competitiveness of an important american industry. i think was a way for them to get money. i think in retrospect, there's a lot of people thinking it might not a bit better -- it might've been better not to have done that. host: medtronic's is quoted in "usa today" saying it expects to pay 120 million dollars in device taxes this fiscal year. maryland, democratic caller. caller: hello? good morning, how are you? i would like to speak to the gentleman because i am 84 years old. in 2003 i lost a kidney. two years ago i had to have a complete shoulder replacement. just a year ago i had to have a pacemaker. i look at the bill that i got if i hadn't had the medicare programs, i could not have afforded that bill. right now i pay $150 for an office visit for my shoulder. $90 for my pacemaker. i only get $746 a month social security. you tell me how i can afford
anything out of that small amount, and i started paying social security under president roosevelt. host: mr. levitt? guest: i'm interested to know how the caller is feeling. it sounds like she is pedro whole lot of difficulty. i hope things are doing well for you now. host: i apologize, governor, she is in on the line. guest: let me respond to her question. medicare is a very important program to all americans. we all have parents, we all look to when we will be in the summer situation when our health to be fragile. we are all very glad we have medicare and should do nothing that would stand between people and having that kind of care.
i'm glad to hear she received it. i also believe she makes a good point where people make a lot of money, really ought to pay more than people like her who live on a fixed income. i have been an advocate for many years that people with wealth ought to pay a little more for what they get with medicare than people who don't. i have a son who is in his 30s. he struggles with his family to raise his four little girls. every month he gets a paycheck that money is taken out of his paycheck to pay for people who make a lot more money than he does for getting medicare. that doesn't seem fair. i think that is one of the ways in which over time we can bring medicare back to a sense of balance is beginning to think about the caller as opposed to people who make a lot of money and why should they pay the same thing. host: an individual tweets -- guest: the premiums depend on
the nature of the person's age, and to some extent, where they live and marketplace where they're consuming services. everyone has a bit of a different situation. that is one of the things that makes it a difficult thing to implement properly. host: florida, independent caller. caller: yes. host: you're on the air, go ahead. caller: i want to know about the co-pay. we stood pay $50 for the emergency room. it went from $50 since this has come to a head, and the last time we went to the emergency
room it was a $300 co-pay. i want to know how many doctors are actually signed up for all of this right now. guest: well, that is a question that i don't know the answer to. i will say that co-pays and adaptable's have become a bigger part of almost every insurance plan. one of the reasons it is done is not just to share the cost, it is also to make people think before they just run off to an emergency room. in most cases, those charges are waived for situations where preventive health, immunizations and physicals and mammograms and other things that are important for people to have to prevent a serious illness or injury. host: here is an e-mail from one of our viewers --
guest: well, i think he points to a trend that is quite prominent in people's lives. like the medicare funds now are just dramatically underfunded, meaning that the costs are so much higher than the amount they bring in. it is almost half of all of the funds with medicare actually come from taxpayer dollars. and so they're just fighting to find a way to balance all of this. so i think hanks expresses not unusual. it is probably one we will see -- it is one of the reasons we have to find a way to deliver care in a more efficient manner. --
guest: guest: well, i agree with that statement to the extent i believe there is a widely held aspiration among republicans, independents, and democrats that we want all americans to have access to affordable health insurance policy. i think that is not the issue. i think the question is, how is it paid for? how much money do we take from one person to pay for another? that is always the dilemma and it is really the case here. host: florida, democratic caller. caller: thank you for allowing me to take this call. i spent my whole career in health care. i was working for one of the largest insurance companies in new york state at that time. it was before medicare passed. we have had something like
650,000 people enrolled at that particular time, and about 4200 doctors, nurses and other groups -- it was a prepaid route to system in new york. there were only a handful of insurers at that particular point. within five years and our enrollment grew to 850,000. the number of employees jumped to about 6200. to me, this is a stimulus program that is proven in the medicare -- you know, wall street got there stimulus package. this is a stainless package for people to save lives. guest: well, the caller makes a valid point. a very high percentage
-- the idea that it is just about health care, i do not think we ought to be spending more on health care just provide jobs. it certainly is a byproduct of what has happened. >> from medicare part b, you have cited, crisis management teams created to come up with metrics engaging in dealing with technology glitches. how did that work echoplex we created teams in anticipation that we would have trouble area that could deal with the problems, separate from those having to deal with the ongoing management of the program.
it turned out to be a wise decision. just like they are experiencing now, there was a need to have people fixing software glitches. they were the same people having to run the computers and take care of other matters. they would have to have stopped doing that. we had six weeks. there was a time when secretary, i was in 20 states in 13 days, trying to keep people calm, to say, we are working on fixing this, be patient. some of the things going on now. we made a decision we wanted to be transparent about the way in which we were making progress. we created some metrics, numbers by which we could measure our progress. every few days, we would say, here is how we are progressing. it gave people a sense of comfort to know we were disclosing where we were. it is a little bit like being on
an airplane. butakes you your dictated it helps when the captain comes on and says it would be another 15 minutes. at least you know what to expect. that was my advice and the washington post op-ed piece i you to the administration, will have these problems, do your best to be transparent and tell people. obamai on twitter says cannot sell his health care -- done an effective job selling this? >> time will tell. i will say this. we started about 15 months in advance building partnerships in hundreds of communities across the country. public libraries and pharmacies
and churches and shopping centers and doctors and hospitals and schools and anyone we could find who had an to help in being able educate a joint constituency. we then spent months and months. from towne would go to town and had three of them going. television ads and lots of other things. do that.ell funded to i do not know how well it -- well funded the current administration is. we startedaying about 15 months in advance and they have chosen to do it a slightly or much different way. my guess is they will have successes in some areas and failures in others. it is a big job. >> during the six weeks you were implementing medicare part the -- d, did you ever get in
yield -- year. the president about how it was going? >> might euros were full all the time. the truth is, i had conversations with the president. on the third or fourth day, it was becoming clear things would be bumpy. he wanted to know how it was going. i gave him regular reports. what they are going through is not is similar to what we were going through. the question is not will that will happen. these things are going to happen. it is how you respond. can you find the problem? can you fix the problems? can you finish them? succeedpy to say we did in smoothing it out and people were very happy with the program. by the time we got into full
implementation where people were having coverage, it has become an important part of people's health care. and 84-year-old woman who called earlier and talked about the pacemaker and shoulder that happened,re she would not have been able to have the medications required to make it a success. many people did not have medications and therefore had operations that could have been avoided if they had the medications. these are difficult things to do and we will see how the administration does with it. ongoingalso have an debate about whether or not the way it is being done is the best way. >> you have called it a success. implementing it took time. did it also take democrats coming to the table to agree to changes in medicare part d to if you look back on that and you will see the debate
was almost identical. the parties were reversed. that time, it was the democrats saying it needs to be delayed, etc.. now it is the other party doing that. the situations are different. this was about prescription drugs. this is all about the insurance. it is about everybody. this is a much bigger deal. am bound to create more of a stir. in time, i think once this all settles in, there will have to be changes to the law. there does not seem to be any political construct right now for that to happen. >> independent color. >> hello. i was calling about responsibility, one of the things we always hear about people, not buying insurance and waiting until the last minute.
i know fromhings people i have spoken to it was not because they were not responsible but because they have had bad experiences like family members who have paid their it -- paid their premiums, needed insurance, and were denied by the company. what insurance can you give orple about the penalties mandates that will be on the insurance companies if they ever denied claim? i know people want to make sure the claim will be paid and will not be left hung out to dry. can you explain some of those penalties? thank you. >> i am not in a position to do any of those things as i am no longer a part of the government. i am sure there are those responsible to oversee the enforcement of the law. if there are frauds committed. there unfortunately always are people who try to take advantage of it. right -- they strike quickly.
consumers need to call their insurance department and ask for a promptask for address of it. thereot deny the fact are in equities and things that occurred that should. there always have been and probably always will be. one of the things we have to do is advocate for ourselves. >> in ohio, this comment. we are still getting ripped off -- republican color. >> hello. i have a comment. 2012 and the clinic in had a corneal transplant. emergency room visit i had. i never go there. it was with my insurance, a three hundred $50 co-pay.
10 months later, this year, i went in june for my second one. i knew i had 15%. i have already been billed $1500 for the same surgery i had 10 months ago. i know they took huge dollars out of medicare to fund this. i do not think it could or should be compared to part d because this was rammed through in the middle of the night basically by one party. it affects the whole country. that is totally different, in my view. is laying offic many people. they are saying it is not entirely due to the health care law. pickingow is they are winners and losers. i work for 40 years. i did not retire until i was 67 years old. 1200 a month coming in and he said i could keep my insurance. i guess i could keep it, but i
have to change it because it is priced out now. people need to realize he is taking from one to give to another. single-payer is what the ultimate plan is. that is my comment. thank you for listening and god bless america. >> thank you for calling in. on twitter -- i will go to caroline, democratic color. >> thank you for taking my call. i want to ask you a question. my comment was by think there was misinformation you said about paying for the affordable care act. as you know, there are billions of dollars of uncompensated care currently being paid for. people will go into emergency rooms and do not have health
care. part of the affordable care act will minimize the uncompensated care. there is also federal workers that will be hired. there is fraud there. >> as we indicated, only a portion was taken from medicare. as for the caller, they got that correct. problems in how the affordable care act is going to be paid for on time. that will play out. host: thank you for joining us and talking to our viewers. guest: i enjoyed it. >> on the nest washington journal, we discussed the government shutdown. after that we will hear about